多层螺旋CT灌注成像技术对肝硬化储备功能的评估

Evaluation of liver reserve function with multi-slice spiral CT perfusion imaging

目的:探讨肝脏多层螺旋CT(multi-slice spiral CT,MSCT)灌注成像技术评估肝硬化储备功能的临床应用价值.方法:CT动态灌注扫描技术,对32例肝癌伴有不同程度肝硬化之肝脏的肝血流量(BF)、血容量(BV)、平均通过时间(MTT)、肝动脉分数(HAF)、对比剂到达时间(IRF To)、门静脉灌注量(PVP)和肝动脉门静脉灌注比率(A/V)等进行研究,并根据CT形态学分级将肝硬化分为轻、中、重三组(轻度组17例、中度组8例、重度组7例),研究其CT灌注参数与肝硬化CT形态学分级、肝功能Child-Pugh分级三者间的相关性.典则判别函数分析CT灌注参数对Child-Pugh分级的判别效果,绘制灌注参数ROC曲线并计算曲线下面积,界定肝脏灌注参数判断Child-Pugh分级的临界值.结果:肝硬化CT形态学分级与BF、BV、IRFTo、PVP、MTT、HAF、A/V有显著的统计学差异及相关性(r=-0.848、-0.801、-0.652、-0.864,0.612,0.822,0.824,均P<0.05);CT肝硬化形态学三分级与Child-Pugh分级呈显著正相关(r=0.877,P=0.001);典则判别函数和ROC分析显示,肝脏灌注参数对Child-Pugh分级的判别符合率为90.6%,BF、BV、PVP、判断Child-Pugh分级符合率分别为90.6、87.5、93.8%.结论:肝脏CT灌注成像可作为评估肝癌患者肝硬化严重程度和肝储备功能的重要影像学指标.

AIM： To measure and assess the features of hepatic hemodynamics in patients with hepatocirrhosis using multi-slice spiral CT （MSCT）, and to investigate the value in determining reserve function in liver cirrhosis with CT perfusion imaging. METHODS： A total of 32 patients with varying liver cirrhosis and hepatocellular carcinoma were classified into three groups based on CT morphologic classification： 17 were classified as light liver cirrhosis group, 8 as moderate group and 7 as severe group. The parameters of CT perfusion including BF, BV, MTT, HAF, IRF To, PVP and A/V were analyzed by the CT perfusion 3 software package （GE） with deconvolution method, and the correlations of CT perfu- sion parameters, CT morphologic classification and Child-pugh＇s hepatic functional classification were analyzed. RESULTS： There were significantly statistical difference and correlation of CT morphologic classification of hepatocirrhosis and BF, BV, IRF To, PVP, MTT, HAF, A/V ratio （r = -0.848, -0.801, -0.652, -0.864, 0.612, 0.822, 0.824, all P 〈 0.05）, and the CT morphologic classification of hepatocirrhosis degree was positively correlated with Child-Pugh classification （r = 0.877, P = 0.001）. Based on canonical discriminate function, 90.6% were correctly classified by hepatic perfusion parameters, while according to ROC curve, the CT perfusion parameters of BF, BV and PVP in judging Child-pugh＇s hepatic functional clasification were 90.6%, 87.5% and 93.8%, respectively. CONCLUSION： Hepatic perfusion imaging with MSCT should be valuable to evaluate the cirrhosis degree and hepatic functional reserve in patients with hepatocellular carcinoma,